14060138CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 21962 WOODBURY DR
CONTRACTOR: &+te
0/ ` fioiWo
PERMIT NO: 14060138
OWNER'S NAME: KIRAN RAO
DATE ISSUED: 06/23/2014
OWNER'S PHONE: 4088244507
PHONE NO:
ttA LICENSED CONTRACTOR'S DECLARATION
JOB DESCRIPTION: RESIDENTIAL ❑ COMMERCIAL F]
UPGRADE (E) ELECTRICAL PANEL TO 200AMPS, SAME
�i
License Class Lic. #
LOCATION
N1,prr,402 V4M'E1Z 6 21 I
Contractor Date
I hereby affirm that I am licensed under the provisions of Chapter 9
(commencing with Section 7000) of Division 3 of the Business & Professions
Code and that my license is in full force and effect.
I hereby affirm under penalty of perjury one of the following two declarations:
I have and will maintain a certificate of consent to self - insure for Worker's
Compensation, as provided for by Section 3700 of the Labor Code, for the
performance of the work for which this permit is issued.
Sq. Ft Floor Area:
Valuation: $2000
I have and will maintain Worker's Compensation Insurance, as provided for by
Section 3700 of the Labor Code, for the performance of the work for which this
APN Number: 32639020 00
Occupancy Type:
permit is issued.
APPLICANT CERTIFICATION
I certify that I have read this application and state that the above information is
PERMIT EXPIRES IF WORK IS NOT STARTED
correct. I agree to comply with all city and county ordinances and state laws relating
WITHIN 180 DAYS O + SSUANCE OR
to building construction, and hereby authorize representatives of this city to enter
180 D n, LED INSPECTION.
upon the above mentioned property for inspection purposes. (We) agree to save
7rjR
indemnify and keep harmless the City of Cupertino against liabilities, judgments,
costs, and expenses which may accrue against said City in consequence of the
Issued b ate:
granting of this permit. Additionally, the applicant understands and will comply
with all non -point so�ce he Cupertino Municipal Code, Section
"alions
9 18.
RE- ROOFS:
Signature Date 2� r
All roofs shall be inspected prior to any roofing material being installed. If a roof is
installed without first obtaining an inspection, I agree to remove all new materials for
inspection.
❑ OW E - BUILDER DECLARATION
Signature of Applicant: Date:
I hereby affirm that I am exempt from the Contractor's License Law for one of
the following two reasons:
ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER
I, as owner of the property, or my employees with wages as their sole compensation,
will do the work, and the structure is not intended or offered for sale (Sec.7044,
Business & Professions Code)
I, as owner of the property, am exclusively contracting with licensed contractors to
HAZARDOUS MATERIALS DISCLOSURE
construct the project (Sec.7044, Business & Professions Code).
I have read the hazardous materials requirements under Chapter 6.95 of the
California Health & Safety Code, Sections 25505, 25533, and 25534. I will
I hereby affirm under penalty of perjury one of the following three
maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the
declarations:
Health & Safety Code, Section 25532(a) should I store or handle hazardous
I have and will maintain a Certificate of Consent to self - insure for Worker's
material. Additionally, should I use equipment or devices which emit hazardous
Compensation, as provided for by Section 3700 of the Labor Code, for the
air contaminants as defined by the Bay Area Air Quality Management District I
performance of the work for which this permit is issued.
will maintain compliance with the Cupert' Municipal Code, Chapter 9.12 and
I have and will maintain Worker's Compensation Insurance, as provided for by
Section 3700 of the Labor Code, for the performance of the work for which this
the Health & Safety Code, Sections 550 55 a d 25534.
/ 2�
Owner or authorized agent: Date:',
permit is issued.
I certify that in the performance of the work for which this permit is issued, I shall
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not employ any person in any manner so as to become subject to the Worker's
CONSTRUCTION LENDING AGENCY
Compensation laws of California. If, after making this certificate of exemption, I
become subject to the Worker's Compensation provisions of the Labor Code, I must
I hereby affirm that there is a construction lending agency for the performance of
forthwith comply with such provisions or this permit shall be deemed revoked.
work's for which this permit is issued (Sec. 3097, Civ C )
Lender's Name
APPLICANT CERTIFICATION
Lender's Address
I certify that I have read this application and state that the above information is
correct. I agree to comply with all city and county ordinances and state laws relating
to building construction, and hereby authorize representatives of this city to enter
upon the above mentioned property for inspection purposes. (We) agree to save
ARCHITECT'S DECLARATION
indemnify and keep harmless the City of Cupertino against liabilities, judgments,
costs, and expenses which may accrue against said City in consequence of the
I understand my plans shall be used as public records.
granting of this permit. Additionally, the applicant understands and will comply
with all non -point source regulations per the Cupertino Municipal Code, Section
Licensed Professional
9 18.
Signature Date
GENERAL PERMIT APPLICATION MEP
COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION D
10300 TORRE AVENUE • CUPERTINO, CA 95014 -3255
(408) 777 -3228 - FAX (408) 777 -3333 - buildin0(g1cuoerino.org m1au
— Ivrrn -zrnTM Mm7r Tatnr'aT. RF_T_ECTRICAL 7bUSCELLANEOUS
PROJECT ADDRESS � _ /�O 3�i�
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CITY, STATE, ZIP
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STREET ADDRESS
CITY, STATE, ZIP
FAX
❑ owi,- '❑ c,;A -= R- BUIIAEt ❑ o)xwERACS'T
CONTRACTOR ❑ CONTRACTOR AGENT ❑ AR=MCT ❑ ENGALCR ❑ D1---z.0 ?E:R ❑ ic?.ANr
CO;.'TP.ACIORNAN.E
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LICENSE TYPE �
I BUS. LIC f
CONLTAAYNAI✓?d ,
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FAX
STREET ADDI,ESSWj t-70 - .r�?rQ A e�L .
I CITY, STATE, ZI`S .. /W' f9}F C A s 1 V
I PHONE ^r'► I j
AP-CIUTECT/D\1CxD ERNAI, —=
LICEIgSENUMBER
BUS. LIC,".
COMPAW. NTAME
E-MAIL
FAX
STREET ADDRESS
CITY, STATE, ZIP
PHONE
USE OF ❑ SFD or DUPLEX ❑ MULTI- FAMILY PROJECT IN WILDLANM ❑ YES PROJECT A* ❑ YES
B=ING: ❑ CON& ERCIAL - I URBAN 12\ —MXACE AREA ❑ NO I FLOOD ZONE ❑ NO
IS THE BLDG AN ❑ 1 rS
I EICH= HOIIM? [31"0
DFSCRIPTION OF WORK J f nG n e ,S e c (aA cA,— k—a t:L co 2,o p A-.t,,P
TOTALV,&JUATIOI4:
By my signature below, I certify to each of the oll irtg:
application and the information I have provi d is orrec
ordinances and state laws relating to buil r _ cti
S i mature of Applicant/Agent:
V.
I am u'Te property ovmer or authorized to act e pe e alf. I have read this
h Te read the Description of Work and verify it is accura e. agree to comply v, th all applicable local
orize representatives of Cupertino to enter the above- identired property for inspection purposes.
Date:
SUPP E?lJBI,TT,4L
,.ATION REQTJ=D
IMMO
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CE= H
.h/ PA1isc1.pp_2011.doc revised 06121111
CITY OF CUPERTINO
FFF. ESTIMATOR - BUILDING DIVISION
ADDRESS: 21962 WOODBURY DR
DATE: 06/23/2014
REVIEWED BY: MELISSA
APN: 326 39 020
BP #:
*VALUATION: 1$2,000
*PERMIT TYPE: Electrical Permit
. 11"!q)1, PC.
PLAN CHECK TYPE: Alteration / Addition / Repair
PRIMARY
SFD or Duplex
PENTAMATION
1 REAP
USE:
PERMIT TYPE:
WORK
UPGRADE E ELECTRICAL PANEL TO 200AMPS SAME LOCATION
SCOPE
PME Unit Fee:
$47.00
APPLIANCE / EQUIP TYPE FEE ID QTY UNITS BP FEES
Services 1ERT <200 200 Amps $47
TOTALS: $47.00
iic'�;tl, JJS�rtq€ i 12e'£'k
?'er? ll Pi Fee:
("flh, -r 1h'ch, I:asr)
I'1vinh. Plan C'1xrr.h
111amh. F'C rmt 1`£'e:
C)l ier Plymh Inv).
Phonh. !°eta:
Elec. Plan Check 10. 0 1 hrs $0.00
Elec. Permit Fee: IEPERMIT
JOther Elec /(. Insp. 0.0 hrs $47.00
NOTE: This estimate does not include fees due to other Departments (i.e. Planning, Public works, Pire, sanitary sewer ulstrict, scnool
n :.....:... .. .. mz.,..,,. ,... ,. ,. 1.,...,.,1 .,u tb —HL.....o. , :.,t r,,....r:.,., " i..ilnhlo nnd nro nnhi nn actimnto_ rantart tho l)ont fnr addn'l info_
FEE ITEMS (Fee Resolution 11 -053 f f. 7/1/13)
FEE
QTY /FEE
MISC ITEMS
Plan C Yh,x k /` ew:
A
. 11"!q)1, PC.
F71
PME Plan Check:
$0.00
PME Unit Fee:
$47.00
PME Permit Fee:
$47.00
C'onsfj,ucll.on KM
F71
Administrative Fee: IADMIN
$44.00
Work Without Permit? 0 Yes C) No
$0.00
,fc;tb'cX72c'c'C 1' C17'Jf17Y #g /''t'£':5':
A
Travel Documentation Fee: ITRAVDOC
$47.00
Strom Motion Fee: IBSEISMICR
$0.50
Select an Administrative Item
Bldg Stds Commission Fee: IBCBSC
$1.00
Mi, �. L4A:.
r,
$186.50
$0.001 TOLL FEET!
$186.50
Revised: 04/01/2014
Building Department
City Of Cupertino
10300 Torre Avenue
Cupertino, CA 95014 -3255
Telephone: 408 - 777 -3228
C U P E RT I N O Fax: 408 - 777 -3333
CONTRACTOR / SUBCONTRACTOR LIST
JOB ADDRESS: °LIg62 W,00Dav _D& evoat:n&(o q-5014 -
PERMIT # � Y04 063
OWNER'S NAME: ' V—, 0.(+4
PHONE # ` 468 8'Z+ -4S0'1
GENERAL CONTRACTOR: 4 AArN04
BUSINESS LICENSE
ADDRESS: M704
CITY /ZIPCODE:
*Our municipal code requires all businesses working in the city to have a City of Cupertino business license.
NO BUILDING FINAL OR FINAL OCCUPANCY INSPECTIONS) WILL BE" SCHEDULED UNTIL THE
GENERAL CONTRACTOR AND ALL SUBCONTRACTORS HAVE OBTAINED A CITY OF CUPERTINO
BUSINESS LICENSE.
I am not using any subcontractors:
Signature Date
Please check applicable subcontractors and complete the following informations
Owner /
6112)(14—
Date
SUBCONTRACTOR
BUSINESS NAME
BUSINESS LICENSE #
Cabinets & Millwork
C ment Finishing
Electrical
C_ecak c-
0 z "ff
Excavation
Fencing
Flooring / Carpeting
Linoleum / Wood
Glass / Glazing
Heating
Insulation
Landscaping
Lathing
Masonry
Painting / Wallpaper
Paving
Plastering
Plumbing
Roofing
Septic Tank
Sheet Metal
Sheet Rock
Tile
Owner /
6112)(14—
Date
CUPERTINO
Address
PURPOSE
a /?� 07
SMOKE / CARBON MONOXIDE ALARMS
OWNER CERTIFICATE OF COMPLIANCE
COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION
10300 TORRE AVENUE • CUPERTINO, CA 95014 -3255
(408) 777 -3228 • FAX (408) 777 -3333 • buildinaCa.cupertino.org
Permit No. ! �0 6,9139"
ll # of Alarms Smoke: S Carbon Monoxide: I
This affidavit is a self- certification for the installation of all required Smoke and Carbon Monoxide Alarms for
compliance with 2013 CRC Section R314, 2013 CBC Sections 420.6 and 907.2.11.2 where no interior access for
inspections are required.
GENERAL INFORMATION
Existing single - family and multi- family dwellings shall be provided with Smoke Alarms and Carbon
Monoxide alarms. When the valuation of additions, alterations, or repairs to existing dwelling units exceeds
$1000.00, CRC Section R314 and CBC Sections 907.2.11.5 and 420.6 require that Smoke Alarms and /or Carbon
Monoxide Alarms be installed in the following locations:
AREA
SMOKE ALARM
CO ALARM
Outside of each separate sleeping area in the immediate vicinity of the
bedroom(s)
X
X
On every level of a dwelling unit including basements
X
X
Within each sleeping room
X
Carbon Monoxide alarms are not required in dwellings which do not contain fuel- burning appliances and that
do not have an attached garage. Carbon monoxide alarms combined with smoke alarms shall comply with
CBC Section 420.6 and shall be approved by the Office of the State Fire Marshal.
Power Supply: In dwelling units with no commercial power supply, alarm(s) may be solely battery operated.
In existing dwelling units, alarms are permitted to be solely battery op ated where repairs or alterations do
not result in the removal of wall and ceiling finishes or there is no z by means of attic, basement or crawl
space. Refer to CRC Section R314 and CBC Sections 907.2.11.4 and 420.6.2. An electrical permit is required for
alarms which must be connected to the building wiring.
As owner of the above - referenced property, I hereby certify that the alarm(s) referenced above has/have been
installed in accordance with the manufacturer's instructions and in compliance with the California Building
and California Residential Codes. The alarms have been tested and are operational, as of the date signed
below.
I have read and agree to comply with the terms and conditions of this statement
Owner (or Owner Agent's) Name:
91nii'
,
Signature. .. ..........................,.................. ...............................
Contractor Name:
N{T
10�Date:7
Signature ................ 14./ ..................................... _->.Lic.#
Smoke and COform.doc revised 03118114